Acute mountain sickness - Revision history

Danbot: Add MedicationDose entries (acetazolamide, dexamethasone) with SMW annotations

2026-03-20T18:36:54Z

Add MedicationDose entries (acetazolamide, dexamethasone) with SMW annotations

@@ Línea 112: / Línea 112: @@
 **Prevention - less effective than acetazolamide, better than placebo
 **Treatment of headache (however, important to consider that taking ibuprofen may mask symptoms)
 ==Disposition==

2026-03-15T05:38:35Z

← Revisión anterior		Revisión del 05:38 15 mar 2026
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	*[[Dexamethasone]] 4mg PO q6hr		*[[Dexamethasone]] 4mg PO q6hr
	**Symptom-improvement only; unlike acetazolamide does not aid acclimatization		**Symptom-improvement only; unlike acetazolamide does not aid acclimatization
	*~~Hyperbaric therapy~~		*Portable hyperbaric chamber
			**Useful in conditions which do not allow descent (ie blizzard, avalanche)
			**Simulate descent to 3000-8000ft


	==Prevention==		==Prevention==

2022-05-30T21:38:40Z

Prevention

← Revisión anterior		Revisión del 21:38 30 may 2022
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	*[[Acetazolamide]] prophylaxis		*[[Acetazolamide]] prophylaxis
	**Indicated for patients with history of altitude illness or forced rapid ascent to altitude		**Indicated for patients with history of altitude illness or forced rapid ascent to altitude
	**Start 24hr before ascent and continue for the first 48hrs at peak altitude		**Start 125 mg PO BID 24hr before ascent and continue for the first 48hrs at peak altitude
	**Can be restarted if illness develops		**Can be restarted if illness develops
	**Reduces symptoms of AMS by 75% in patients ascending rapidly to altitudes >8200ft		**Reduces symptoms of AMS by 75% in patients ascending rapidly to altitudes >8200ft

2022-05-30T21:37:37Z

Management

← Revisión anterior		Revisión del 21:37 30 may 2022
Línea 68:		Línea 68:
	**Descend to lower altitude of 300-500m (1000-3000ft) '''OR''' acclimatize for 12-36hr at same altitude		**Descend to lower altitude of 300-500m (1000-3000ft) '''OR''' acclimatize for 12-36hr at same altitude
	*[[Acetazolamide]]		*[[Acetazolamide]]
	**Mechanism: speeds acclimatization by promoting bicarb diuresis		**Mechanism: speeds acclimatization by promoting bicarb diuresis -> metabolic acidosis -> ↑ ventilation
	**Indications:		**Indications:
	***History of altitude illness		***History of altitude illness

2022-05-30T21:35:47Z

Background

← Revisión anterior		Revisión del 21:35 30 may 2022
Línea 6:		Línea 6:
	**NOT based on physical fitness, age, sex, smoking, previous high-altitude experience		**NOT based on physical fitness, age, sex, smoking, previous high-altitude experience
	*Tend to have recurrence of symptoms whenever they return to the symptomatic altitude		*Tend to have recurrence of symptoms whenever they return to the symptomatic altitude
			*Low partial pressure of O2 leads to decreased diffusion of O2 across alveolar spaces -> hypoxemia results in tachypnea and cerebral vasodilation (↓ CO2) -> increased ICP

	==Clinical Features==		==Clinical Features==

2021-05-21T07:26:51Z

Disposition

← Revisión anterior		Revisión del 07:26 21 may 2021
Línea 110:		Línea 110:

	==Disposition==		==Disposition==
			*Most patients are treated symptomatically and managed as outpatients
			*If other high altitude illnesses are considered, consider further work-up and/or observation

	==See Also==		==See Also==

2021-05-21T07:24:34Z

Prevention

← Revisión anterior		Revisión del 07:24 21 may 2021
Línea 101:		Línea 101:
	**4mg PO q12hr		**4mg PO q12hr
	**Prevents and treats cerebral edema		**Prevents and treats cerebral edema
			*Combination [[acetazolamide]] and [[dexamethasone]]
			**Small study showed combination of both (500mg SR daily of [[acetazolamide]] and 4 mg BID [[dexamethasone]]) was more effective at preventing AMS than [[acetazolamide]] alone for rapid ascent <ref>Bernhard WN, Schalick LM, Delaney PA, Bernhard TM, Barnas GM. Acetazolamide plus low-dose dexamethasone is better than acetazolamide alone to ameliorate symptoms of acute mountain sickness. Aviat Space Environ Med. 1998;69(9):883-886.</ref>
	*Ginkgo biloba		*Ginkgo biloba
	**Controversial if effective; safe		**Controversial if effective; safe

2021-05-21T07:19:07Z

Mild

← Revisión anterior		Revisión del 07:19 21 may 2021
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	===Mild===		===Mild===
	*Terminate ascent and/or descend <ref> Luks A, McIntosh S, Grissom C, Auerbach P, Rodway G, Schoene R, Zafren K, Hackett P. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2014 Update. Wilderness Environ Med. 2014; S4-S14.</ref>		*Terminate ascent and/or descend <ref> Luks A, McIntosh S, Grissom C, Auerbach P, Rodway G, Schoene R, Zafren K, Hackett P. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2014 Update. Wilderness Environ Med. 2014; S4-S14.</ref>
	**Descend to lower altitude (by 1000-3000ft) '''OR''' acclimatize for 12-36hr at same altitude		**Descend to lower altitude of 300-500m (1000-3000ft) '''OR''' acclimatize for 12-36hr at same altitude
	*[[Acetazolamide]]		*[[Acetazolamide]]
	**Mechanism: speeds acclimatization by promoting bicarb diuresis		**Mechanism: speeds acclimatization by promoting bicarb diuresis

2021-05-21T07:18:08Z

Moderate-Severe

← Revisión anterior		Revisión del 07:18 21 may 2021
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	===Moderate-Severe===		===Moderate-Severe===
	*Immediate descent for worsening symptoms		*Immediate descent of 500 m (~ 1500 ft) for worsening symptoms
	*Low-flow 0.5-1 L/min [[O2]] if available (especially nocturnal administration)		*Low-flow 0.5-1 L/min [[O2]] if available (especially nocturnal administration)
	*[[Acetazolamide]] 250mg PO BID		*[[Acetazolamide]] 250mg PO BID

2021-05-21T07:13:19Z

Differential Diagnosis